Table of Contents
A.M. Van Eijk et al.
Objective: To study the importance of HIV infection for malaria in pregnancy in Kisumu, Kenya.
Methods: Healthy women with an uncomplicated pregnancy of 32 weeks or more attending the prenatal clinic in the Provincial Hospital between June 1996 and March 1999 were tested for HIV and malaria after consent had been obtained. For participating women who delivered in the same hospital, a blood smear of the mother and the placenta were obtained.
Results: In the third trimester, 5,093 women consented to testing: the prevalence of malaria and HIV was 20.1 and 24.9 percent, respectively. Among the 2,502 [HIV- and malaria-] screened women who delivered in the hospital, the prevalence of HIV, peripheral parasitaemia and placental malaria was 24.5, 15.2, and 19.0 percent, respectively. Compared with HIV-seronegative women, HIV-seropositive women were more likely to be parasitaemic, to have higher parasite densities, and to be febrile when parasitaemic. Placental infections in HIV-seropositive women were more likely to be chronic, as indicated by the presence of moderate to heavy pigment depositions. When adjusted by age, the typical gravidity-specific pattern of malaria in pregnancy disappeared in HIV-seropositive women; HIV-seropositive primigravidae had a similar risk of malaria as HIV-seropositive multigravidae. The excess malaria attributable to HIV in the third trimester increased from 34.6 percent among HIV-seropositive primigravidae, to 41.5 percent among HIV-seropositive secundigravidae, and 50.7 percent among HIV-seropositive gravidae with three or more pregnancies.
Conclusion: HIV infection alters patterns of malaria in pregnant women; in areas with both infections, all pregnant women should use malaria prevention. [AIDS 2003;17(4):595-603.]
Objective: To illustrate how human immunodeficiency virus (HIV) observational databases may be used to monitor trends in HIV treatment and HIV disease outcomes through data reported from the Australian HIV Observational Database (AHOD).
Methods: Time trends in the use of antiretroviral treatment, and changes in treatment strategies were calculated in patients recruited to AHOD from HIV specialist clinics including hospitals, sexual health clinics and general practices. These results were then compared to trends reported from other observational cohorts.
Results: By September 2001, 1,961 patients were recruited to AHOD. Since entering AHOD, 3 percent of patients have been diagnosed with an AIDS defining illness, and 2 percent of patients have died, of which, 54 percent were non-HIV related deaths. The proportion of patients receiving antiretroviral therapy increased from 66 percent between January and June 1998 and 77 percent between July and September 2001. The most commonly received treatment regimen was triple therapy including a protease inhibitor (PI), ranging between 36 percent in January and June 1998 and 31 percent in July to September 2001. Triple therapy including a non-nucleoside reverse transcriptase inhibitor (NNRTI) more than doubled to 32 percent between July and September 2001. The proportion of patients receiving either stavudine (d4T)-containing or zidovudine (ZDV)-containing treatment regimens decreased from 92 percent between January and June 1998 to 76 percent between July and September 2001. Patients receiving ritonavir (RTV) in combination with another protease inhibitor increased, as did the proportion of patients interrupting therapy for more than three months.
Conclusion: These findings suggest there have been changes in the way antiretroviral treatments have been used in Australia, and are consistent with the current literature. Furthermore, these findings demonstrate the usefulness of observational cohorts as a surveillance tool monitoring trends in treatment and disease progression. [J Clin Virol 2003;26(2):209-22.]
S.S. Uppal, S. Verma, and P.S. Dhot
Background: Information on lymphocyte populations (T, B, and natural killer cells) and subpopulations (CD4 and CD8) in India is generally lacking. Measurement of T-cell subsets is important in India for evaluating disease stage and progression in individuals with the human immunodeficiency virus (HIV). Hence, this study was conducted to provide normal ranges of absolute and percentage values of CD4 and CD8 T-lymphocyte subsets and the ratio of CD4 to CD8 in normal Indian adults.
Methods: Flow cytometric analysis (EPICS-XL) was used to determine the range of T-lymphocyte subpopulations in normal Indian blood donors at Command Hospital and the Armed Forces Medical College, Pune, India. The reference population consisted of 94 healthy HIV-seronegative blood donors. T-lymphocyte subsets were analyzed with two-color immunophenotyping of peripheral blood lymphocytes with the use of a lysed whole-blood technique and enumerated.
Results: For normal values of various blood components, we found mean values of 2,114 cells/µl for total lymphocytes, 865 cells/µl (40.2 percent) for CD4 lymphocytes, 552 cells/µl (31.3 percent) for CD8 lymphocytes, and 1.7 for the CD4:CD8 ratio. The 95 percent confidence intervals for the same parameters were 1,115-4,009 cells/µl, 430-1,740 cells/µl (30.75-49.60 percent), 218-1,396 cells/µl (20.06-42.52 percent), and 0.39-3.02 respectively. Females had significantly higher CD4 counts (P<0.05), percentage of CD4 lymphocytes (P<0.01), and CD4:CD8 ratio (P<0.01). Males had a significantly higher percentage of CD8 lymphocytes (P<0.01). They also had higher CD8 counts that did not reach significance. Age, ethnicity (Dravidian versus Aryan), smoking, alcohol consumption, and the interval between drawing the blood sample and its analysis were factors that did not produce statistically significant differences in the T-cell subsets studied.
Conclusion: When compared with other published series, the CD4 and CD8 values in healthy Indians were no different from those reported in the West. These observations have important clinical implications for the use of T-lymphocyte subset measurements in India, especially in the management of HIV infection. [Cytometry 2003;52B(1):32-36.]
N.T. Rotta and A. Legido
Introduction: Forty million people are currently infected with HIV. Of these, 50 percent are women and children. Vertical transmission occurs in 90 percent of the cases reported in the literature and was also observed by the authors of the present study at Hospital de Clinicas de Porto Alegre, Brazil, in the follow up of 340 HIV-positive children since 1985. Transmission can occur during pregnancy (intrauterine) or during labor and delivery (intrapartum). In addition, HIV has been identified in the breast milk of infected mothers, which represents a contraindication for breastfeeding in these cases. Laboratory diagnosis is carried out using the following tests: ELISA, Western blot, and indirect immunofluorescence.
Development: Neurological manifestations in children may be divided into primary neurological diseases and secondary complications. Primary neurological diseases include both static encephalopathy, of slow evolution, and progressive encephalopathy, which affects neuropsychomotor development. The follow up of 340 children with AIDS showed encephalopathy in 32.5 percent of cases and delayed neuropsychomotor development in 42.5 percent. Opportunistic infections occurred in 33.8 percent of cases (one infant presented meningoencephalitis). One child presented lymphomas, 2.6 percent had cerebrovascular accidents, and 5 percent had peripheral neuropathies. Currently, 54 children of those followed since birth are over 10 years of age, and of these, 31 (57 percent) present neurological symptoms, 40 percent with encephalopathy, and 30 percent with neurological complications; the remaining children present educational, behavioral, and developmental difficulties.
Conclusion: Several factors have influenced the natural history of AIDS in childhood, such as early diagnosis, drug regimen used, social, economic, and nutritional conditions, as well as health practices aimed at this population. [Rev Neurol 2003;36(1):255-63.]